IS LAPAROSCOPIC ADRENALECTOMY INDICATED FOR PHEOCHROMOCYTOMAS

Background. Since the introduction of laparoscopic adrenalectomy there has been major concern about proper indications for its use, includin g in pheochromocytoma. In this study we reviewed pheochromocytomas res ected by means of laparoscopy to establish that procedure's usefulness . Methods. Between January 1992 and June 1995, 90 laparoscopic adrenal ectomies were performed in 82 patients. Three to five trocars were use d intraperitoneally in each patient to remove the gland, and extractio n was performed with a sterile plastic bag. Results. Twenty-three pheo chromocytomas were operated on. Six patients had a bilateral adrenalec tomy. Pheochromocytomas were significantly larger than other tumors, r equired more operating time, and necessitated longer hospital stays in patients. Of all the intraoperative complications 87% occurred in the pheochromocytoma to the liver was unexpectedly found, and in one case metastasis from a medullary thyroid carcinoma was found. There has be en no local recurrence after laparoscopic adrenalectomy. Conclusions. Laparoscopic adrenalectomy for pheochromocytomas is difficult because tumors are larger and more complications are seen related to their hor monal secretion, in spite of adequate pharmacologic blockade. However, metastatic extensions can be diagnosed and laparoscopic ablation can be performed in most instances without recurrence. It is not, therefor e, a contraindication for this approach.